Patient Survey Quick Links Premier Urgent Care Logo We’d love to hear your thoughts about our clinic and how we can help better serve you. Please fill out the survey form below…thank you! Please provide your contact info: First Name*Last Name*Phone NumberPlease tell us how you found out about Premier Imaging :---Premier Urgent CareFamily / FriendInternet SearchTelevisionRadioWorkplaceNewspaperEmailWebsiteDoctor ReferralOtherBillboardDirect MailerDo you have a regular family doctor?YesNoIf Premier Imaging was not here, where would you have gone for treatment?Emergency RoomFamily DoctorWould have had no treatmentOtherHave you previously visited this location of Premier Imaging?YesNoHow would you rate:Overall quality of medical care?ExcellentGoodFairPoorCourtesy and helpfulness of front desk staff?ExcellentGoodFairPoorCourtesy and professionalism of Radiology Staff?ExcellentGoodFairPoorDuring your visit were you periodically informed of the status of your treatment and offered water or other conveniences?YesNoDid you Radiology Tech offer the option of having access to your results electronically.YesNoBased on your recent appointment, how would you rate your Radiology Tech listens to youExcellentGoodFairPoorTakes Enough Time with youExcellentGoodFairPoorExplains the radiology test results and how long before you will get resultsExcellentGoodFairPoorSatisfaction with your Plan of Care.ExcellentGoodFairPoorCleanliness and neatness at Premier Imaging?ExcellentGoodFairPoorClear communication and instructions during visit?ExcellentGoodFairPoorHow would you rate your wait time in CT SuiteExcellentGoodFairPoorWas the cost of your visit reasonable?YesNoHow likely would you be to refer to friends & relatives?Very LikelySomewhat LikelySomewhat UnlikelyNot at all LikelyOverall, how would you rate your Experience?ExcellentGoodFairPoorOverall, were you satisfied enough to return to our Imaging Center in the future?YesNoWould you be willing to share your experience in Premier Imaging marketing initiatives?YesNoWhat was the date of your visit? We’d like to hear any comments you might have about your visit to Premier Imaging.To improve our services and better serve our clients, we may wish to contact you regarding your feedback. What is your e-mail address? (Note that your e-mail address will only be used to contact you if appropriate and will not be used for any other purpose.) : This iframe contains the logic required to handle Ajax powered Gravity Forms.
